Friday, November 17, 2017

Although there has been a
dramatic increase in the research and clinical studies related to children and
adolescents, there is a paucity of information regarding more capable adults on
the autism spectrum. It is only recently that psychologists have begun to
appreciate the complex challenges faced by a “lost generation” of adults with
autism spectrum disorder (ASD).Even though
the core symptoms of ASD (impairments in communication and social interaction
and restricted/repetitive behaviors and interests) may improve overtime with
intervention for many individuals, some degree of impairment typically remains
throughout the lifespan.Consequently,
the focus of intervention/treatment to promoting adaptive behaviors that can facilitate and enhance
ultimate functional independence and quality of life in adulthood. This includes
new developmental challenges such as independent living, vocational engagement,
post-secondary education, and family support.

Decision-making is an
important part of almost every aspect of life. However, several autobiographical accounts
(e.g., Temple Grandin) suggest that making decisions can be stressful and anxiety-provoking for many autistic adults. Likewise, a small number of studies have suggested differences between the decision-making experiences of adults on the spectrum and their neurotypical peers. Despite autobiographical accounts and
limited studies, the extent to which, in everyday life, autistic individuals experience difficulties with decision-making is largely unknown.

Research

A study published in the
journal Autism sought to extend this
important area of research by comparing the “real-life” decision-making
experiences of adults with and without autism spectrum disorder (ASD). The researchers hypothesized that compared
with a neurotypical group, participants with ASD would report: (a) more
frequent experiences of problems during decision-making (e.g. feeling
exhausted), (b) greater difficulty with particular features of decisions (e.g.
decisions that need to be made quickly), and (c) greater reliance on rational,
avoidant, and dependent styles of decision-making. In addition, it was expected
that participants with ASD would report interference from their condition when
making decisions.

The participants were 38
adults with ASD and 40 neurotypical comparison adults (with no family history
of ASD), aged 16 to 65 years. The groups were matched for age, gender and
verbal IQ. All participants completed a novel questionnaire to evaluate their
decision-making experiences. The questionnaire asked participants to rate: (a)
the frequency with which particular problems in decision-making were
experienced; (b) the extent to which they perceived difficulties in relation to
particular features of decisions; and finally, (c) the extent to which
participants with ASD believed that their condition enhanced or interfered with
their own decision-making. Ratings of the frequency of 12 potential problems in
decision-making were indicated on a four-point Likert-type scale (from ‘never’
to ‘often’). Participants also completed the General Decision Making Style
Inventory (GDMS), a 25-item questionnaire probing reliance on five, non-
mutually exclusive, styles of decision-making (rational, intuitive, dependent,
avoidant, and spontaneous). Levels of anxiety and depression were assessed
using the well- established Hospital Anxiety and Depression Scale (HADS).

Results

Compared with their neurotypical peers, the participants with ASD more
frequently reported difficulties in decision making. Decisions that needed to
be made quickly, or involved a change of routine, or talking to others, were
experienced as particularly difficult, and the process of decision-making was
reported to be exhausting, overwhelming, and anxiety-provoking. The participants
with ASD reported significantly higher levels of anxiety and depression and were
more likely to believe that their condition interfered with rather than
enhanced the decision-making process. Not surprisingly, the participants with
ASD were also more likely to report that they avoided decision-making.

Conclusion and Implications

The overall findings of
the study suggest that, compared with neurotypical individuals, autistic individuals experience greater difficulty with decision-making. Decision-making in
ASD was associated with anxiety, exhaustion, problems engaging in the process,
and a tendency to avoid decision-making. These findings are consistent with
previous autobiographical accounts, known features of the condition, and
previous studies of decision-making in autism. In addition, the difficulties
reported by the participants with ASD may be exacerbated by higher levels of
anxiety and depression. The researchers found that ratings of perceived
frequency of interference from ASD increased proportionally with levels of
anxiety and depression. Despite limitations of the study (e.g., self-reports),
the results are consistent with suggestions from the literature relating to
decision-making for individuals with ASD. There are also some practical
implications for improving the decision-making process for autistic adults. For example, it may
be helpful to: (a) provide additional time to reach a choice, (b) minimize
irrelevant information, (c) present closed questions, (d) offer encouragement
and reassurance, and (e) address general issues around anxiety. Unfortunately, expecting to make the
perfect decision, postponing and second-guessing a choice, all leads to more
anxiety. Strategies derived from cognitive-behavioral therapy (CBT) might be helpful in coping with indecisiveness and perfectionism by focusing on accepting life’sunpredictability and changing behavior to more effectively
work toward a goal. This includes examining
several sides of an issue, and creatively generating options for action, all in
the effort to engage in more thoughtful, realistic, and productive
decision-making. Understanding
how autistic adults experience decision-making is essential for both family members and professionals in helping the individual achieve greater self-understanding, self-advocacy and improved
decision-making in lifespan activities such as employment and personal
relationships.

A Best Practice Guide to Assessment & Intervention for Autism Spectrum Disorder in Schools (2nd Edition) was selected as an Award-Winning Finalist in the "Education/Academic" category of the 2017 Best Book Awards. Fully updated to reflect current assessment tools, procedures and research, this award-winning book provides a practical and scientifically-based approach to identifying, assessing, and treating children and adolescents with an Autism Spectrum Disorder (ASD) in school settings. Integrating current research evidence with theory and best practice, each chapter features a consolidated and integrative description of best practice assessment and intervention approaches for children and youth with ASD. It brings the topics of assessment and intervention together in a single authoritative resource guide consistent with recent advances in evidence-based practice.Illustrative case examples, glossary of terms, and helpful checklists and forms make this the definitive resource for identifying and implementing interventions for school-age children and youth with ASD.This Guide is intended to meet the needs of school-based professionals such as school psychologists, counselors, speech/language pathologists, occupational therapists, counselors, social workers, administrators, and both general and special education teachers. Parents, advocates, and community-based professionals will also find this guide a valuable and informative resource.

“It is rare that one book can pack so many resources and easy to digest information into a single volume! Families, school personnel, and professionals all need the extensive, and up-to-date tips, guides, and ‘must-knows’ provided here. It’s obvious the author is both a seasoned researcher and practitioner – a winning combination.” — Dr. Debra Moore, psychologist and co-author with Dr. Temple Grandin, of The Loving Push: How Parents & Professionals Can Help Spectrum Kids Become Successful Adult

“Dr Wilkinson has done it again. This updated and scholarly Second Edition reflects important recent changes regarding diagnosis and services for students with Autism Spectrum Disorder. With its numerous best-practice suggestions, it is a must-read for school psychologists, school social workers, and those who teach in general and special education.” — Dr Steven Landau, Professor of School Psychology in the Department of Psychology, Illinois State University

“This book is an essential resource for every educator that works with students with ASD! The easy-to-read format is complete with up to date research on evidence-based practices for this population, sample observation and assessment worksheets and case studies that allow the reader to apply the information presented.” — Gena P. Barnhill, PhD, NCSP, BCBA-D, LBA, Director of Special Education Programs at Lynchburg College, Lynchburg, VA

Wednesday, November 15, 2017

Part of the Applying
Psychology in the Schools Series, Autism Spectrum Disorder in
Children and Adolescents: Evidence-Based Assessment and Intervention in Schools,
is an essential reference for professionals in need of the most recent and
reliable research information on identifying and providing
interventions for the increasing number of children with autism spectrum
disorder (ASD).This book is an
authoritative resource that presents up-to-date research and evidence-based
tools for accurate assessment and intervention. It includes procedures to help
identify children using the new DSM-5 symptom criteria and offers essential
guidance for assessing a variety of emotional, behavioral, and academic
problems. The book provides
practitioners with an evidence-based assessment battery, which includes tests
of cognitive, academic, neuropsychological, and adaptive functioning. The
pragmatic, social-communicative functions of language are considered together
with assessments to identify language deficits. Readers also learn to
identify co-occurring emotional and behavior problems of children with ASD and understand techniques and strategies to enhance home-school partnerships and engage parents as active partners in the decision-making process. Each chapter is based on
the principles of evidence-based practice. Many chapters feature case
vignettes to illustrate best practice in the school setting. The volume concludes with
a primer on ASD-related litigation issues and discusses relationships between
special education law, provision of services, and placement decisions.

"This fantastic resource
is a must-read for professionals and students across many disciplines.
Contributors provide critical information on a comprehensive range of topics
with an emphasis on evidence-based approaches and practical applications." -Natacha Akshoomoff, PhD, Associate Professor, Department of Psychiatry and
Center for Human Development, University of California, San Diego"Autism Spectrum
Disorder in Children and Adolescents: Evidence-Based Assessment and
Intervention in Schools serves as an excellent resource for professionals
working with children with ASD in educational settings and covers many
fundamental aspects that need to be considered in assessment and intervention
practices. Overall, this book thoroughly integrates current research and theory
as well as relevant practice in school settings and will allow practitioners to
further their conceptual understanding of assessing and treating ASD."- Canadian Journal of
School Psychology

“Wilkinson has put
together a book that is quite readable and interesting. Difficult concepts are explained
clearly but concisely. The style and quality of writing is consistently good
across chapters. A strength of this book is the breadth of coverage. The
authors meet the goal of providing professionals with information on ASD,
screening, assessment, and interventions for the classroom.” - Journal of
Psychoeducational Assessment

"This concise book provides
a comprehensive and very readable introduction to best practices in the
assessment and treatment of ASD in school settings. It succinctly informs the
professional reader about the theoretical and research foundations underlying its
many suggestions for practice, which are further enhanced by the liberal use of
vignettes." -PsycCRITIQUES

"An excellent and
accessible synthesis of the evidence base for school-based interventions in ASD
and a comprehensive look at the psychological profile of the child with autism."
- The Association for Child and
Adolescent Mental Health

"In
its current form, Wilkinson has fashioned a very good book for ASD
school practitioners, with commendable interdisciplinary appeal and a
much needed dose of empiricism!"-New England Psychologist “Overall,
Wilkinson’s text is like a guided tour of the parallel yet overlapping worlds
of school and clinical practice, which many of our patients and families
navigate daily. It will contribute to the reader’s knowledge of ASDs and more
broadly of how schools accommodate and work with special-needs children.” – Journal
of the American Academy of Child & Adolescent Psychiatry

Tuesday, November 7, 2017

Since Congress
added autism as a disability category to the Individuals with
Disabilities Education Act (IDEA), the number of students receiving
special education services in this category has increased over 900 percent
nationally. The number of students receiving assistance under the special
education category of autism over the past decade has increased from 1.5
percent to 9 percent of all identified disabilities. Autism now ranks fourth
among all IDEA disability categories for students age 6-21. It’s critically important that parents and educators understand the provisions
for providing legally and educationally appropriate programs and services for
students identified with autism spectrum disorder (ASD).

Research indicates
that education is the most effective treatment/intervention for children with
ASD. The most recent re-authorization of the Individuals with Disabilities Education Act (IDEA 2004) entitles
all students with disabilities to a free, appropriate public education (FAPE).
FAPE encompasses both procedural safeguards and the student’s individual
education program (IEP). The IEP is the cornerstone for the education of a
child with ASD. When a student is determined eligible for special education
services, an IEP planning team is formed to develop the IEP and subsequently
determine placement.

Although clinical
diagnoses, psychiatric reports, and treatment recommendations can be helpful in
determining eligibility and educational planning, the provisions
of IDEA are the controlling authority with regard to decisions for
special education. While clinical information is professionally helpful, it is
neither legally required nor sufficient for determining educational placement.
Therefore, it’s especially important for administrators, parents, advocates,
teachers and non-school professionals to keep in mind that when it comes to
special education, it is state and federal education codes and regulations (not
clinical criteria) that determine eligibility and IEP planning decisions.

According to IDEA regulations, the definition of autism is as follows:

(c)(1)(i) Autism means a developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age 3, that adversely affects a child’s educational performance. Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences. The term does not apply if a child’s educational performance is adversely affected primarily because the child has an emotional disturbance, as defined in this section.(ii) A child who manifests the characteristics of ‘‘autism’’ after age 3 could be diagnosed as having ‘‘autism’’ if the criteria in paragraph (c)(1)(i) of this section are satisfied.

Guidelines

Legal
and special education experts recommend the following guidelines to help school
districts meet the requirements for providing legal and appropriate educational programs and services to students with ASD.

1. School districts
should ensure that the IEP process follows the procedural requirements of
IDEA. This includes actively involving parents in the IEP process and adhering
to the time frame requirements for assessment and developing and implementing
the student’s IEP. Moreover, parents must be notified of their due
process rights. It’s important to recognize that parent-professional
communication and collaboration are key components for making educational and
program decisions.

2. School districts should
make certain that comprehensive, individualized evaluations are completed by
school professionals who have knowledge, experience, and expertise in ASD. If
qualified personnel are not available, school districts should provide the
appropriate training or retain the services of a consultant.

3. School districts should
develop IEPs based on the child’s unique pattern of strengths and weaknesses.
Goals for a child with ASD commonly include the areas of communication, social
behavior, adaptive skills, challenging behavior, and academic and functional
skills. The IEP must address appropriate instructional and curricular
modifications, together with related services such as counseling, occupational
therapy, speech/language therapy, physical therapy and transportation needs.
Evidence-based instructional strategies should also be adopted to ensure that
the IEP is implemented appropriately.

4. School districts should
assure that progress monitoring of students with ASD is completed at specified
intervals by an interdisciplinary team of professionals who have a knowledge
base and experience in autism. This includes collecting evidence-based data to
document progress towards achieving IEP goals and to assess program
effectiveness.

5. School districts should
make every effort to place students in integrated settings to maximize
interaction with non-disabled peers. Inclusion with typically developing
students is important for a child with ASD as peers provide the best models for
language and social skills. However, inclusive education alone is insufficient,
evidence-based intervention and training is also necessary to address specific
skill deficits. Although the least restrictive environment (LRE) provision of IDEA
requires that efforts be made to educate students with special needs in less
restrictive settings, IDEA also recognizes that some students may require a
more comprehensive program to provide FAPE.

6. School districts should
provide on-going training and education in ASD for both parents and
professionals. Professionals who are trained in specific methodology and
techniques will be most effective in providing the appropriate services and in
modifying curriculum based upon the unique needs of the individual child.

National Research Council
(2001). Educating children with autism. Committee on Educational
Interventions for Children with Autism. C. Lord, J. P. McGee (Eds).
Division of Behavioral and Social Sciences and Education. Washington, DC:
National Academy Press.

Wednesday, November 1, 2017

Anecdotal reports and
empirical evidence suggest that atypical or unusual sensory responses are a
common feature of autism spectrum disorder (ASD). Studies
report that from 45 to more than 90 percent of people with autism
either ignore or overreact to ordinary sights, sounds, smells or other
sensations. Sensory issues are now
included in the DSM-5 symptom criteria for restricted, repetitive patterns of
behavior, interests, or activities (RRB). This includes hyper-or hypo-reactivity
to sensory input or unusual interest in sensory aspects of the environment;
such as apparent indifference to pain/heat/cold and adverse response
to specific sounds or textures. Although no one single type of sensory problem is consistently associated
with ASD, auditory sensitivity is often cited as the most disturbing and
challenging for autistic individuals.

We live in an incessant cacophony of noise. In
fact, scientists say it’s the noisiest age in human history. We know that “noise pollution” can cause hypertension, high stress
levels, tinnitus, hearing loss, sleep disturbances, and other harmful effects.
Sound becomes unwanted when it either interferes with normal activities such as
sleeping, conversation, or disrupts or diminishes one's quality of life. Certain
sounds are particularly annoying collectively to us all. However, many of the
everyday noises other people take for granted can be very painful and cause
unwanted intrusions for autistic adults. For example, many autistic adults report sound sensitivity problems such as
hyperacusis, misophonia, hypersensitive hearing at certain frequencies, and phobias (phonophobia) related to specific sounds. When present, sensory problems can interfere with adaptability in many areas of
life (communication, daily living, socialization, occupational). Understanding
sensory issues in adults on the autism spectrum is critical to the identification and
prescription of appropriate interventions especially considering studies that suggest a
link between anxiety and sensory over-responsivity which can further compromise an individual's ability to function successfully in daily life.

Research

A study published in Autism investigated
sensory over-responsivity in adults compared to control participants
and the extent to which daily life experiences were endorsed as uncomfortable
or distressing by those on the spectrum. The researcher’s hypothesized that adults
with autism would report more sensory over-responsivity than controls. A second
objective was to test whether sensory over-responsivity is linked to autistic
traits in adults with and without autism.

Adults with (n = 221) and
without (n = 181) autism spectrum conditions participated in an online survey.
The Autism Spectrum Quotient (AQ), the Raven Progressive Matrices and the
Sensory Processing Scale were used to characterize the sample. Adults with
autism spectrum conditions reported more sensory over-responsivity than control
participants across all sensory modalities (vision, hearing, touch, smell, taste and proprioceptive). However, the highest mean scores were reported for Hearing and Touch on the Sensory Processing Scale.

These findings highlight the importance of measuring each
sensory domain separately rather than combining scores from various sensory
domains. Notable in this study was the
association between sensory over-responsivity and autistic traits. Increased
sensory sensitivity was associated
with more self-reported autistic traits, both across and within groups. These
results indicate that autistic adults experience
sensory over-responsivity to daily sensory stimuli to a high degree and that a positive
relationship exists between sensory over-responsivity and autistic traits.

Implications

Despite its limitations,
this study shows that autistic adults self-report over-responsivity across
multiple sensory domains (vision, hearing, touch, smell, taste and proprioceptive) that affect their daily life routines and thus quality
of life. Auditory over-responsiveness was among the most frequently reported by participants indicating that autisticadultsexperience challenges
to daily auditory stimuli to a high degree. Although sensory symptoms may improve with maturation for typical individuals, sensory features in
ASD remain stable and often become more challenging during adulthood. Likewise, sensory over-responsivity
has also been linked to higher rates of depression and anxiety. Although there is no cure for sensory sensitivity, there are various
techniques as well as some lifestyle modifications that can tone down the
symptoms of auditory sensitivity, so it does not severely interfere with everyday
life. They includeexposure and response prevention
(E/RP) treatment; habituation training, applied relaxation, positive imagery,
attention shifting, psychoeducation, cognitive restructuring, and background
sounds to cope with hyperacusis. The most effective solutions involve
increasing the tolerance of noise by exposing the person to sufficient noise to
build up his or her “immunity.” Over-protection may only further increase the
effect of extreme sensitivity to sound. Evaluating and attending to over-responsivity have
implications for understanding and addressing the sensory components of autistic adults' daily life routines and roles. Appropriate intervention should be directed
towards sensory issues that may be contributing to emotional and psychological
challenges and towards designing sensory friendly domestic and work environments.

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The objective of bestpracticeautism.com is to advocate, educate, and informby providing a best practice guide to the screening, assessment, and intervention for school-age children on the autism spectrum. Timely articles and postings include topics such as screening, evaluation, positive behavior support (PBS), self-management, educational planning, IEP development, gender differences, evidence-based interventions (EBI) and more. This site also features up-to-date information on scientifically validated treatment options for children with ASD and a list of best practice books, articles, and links to organizations. Designed to be a practical and useful resource, bestpracticeautism.com offers essential information for psychologists, teachers, counselors, advocates and attorneys, special education professionals, and parents.

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Praise for "A Best Practice Guide..."

“It is rare that one book can pack so many resources and easy to digest information into a single volume! Families, school personnel, and professionals all need the extensive, and up-to-date tips, guides, and ‘must-knows’ provided here. It’s obvious the author is both a seasoned researcher and practitioner – a winning combination.” - Dr. Debra Moore, psychologist and co-author with Dr. Temple Grandin, of The Loving Push: How Parents & Professionals Can Help Spectrum Kids Become Successful Adult

“Dr Wilkinson has done it again. This updated and scholarly Second Edition reflects important recent changes regarding diagnosis and services for students with Autism Spectrum Disorder. With its numerous best-practice suggestions, it is a must-read for school psychologists, school social workers, and those who teach in general and special education.” - Dr Steven Landau, Professor of School Psychology in the Department of Psychology, Illinois State University

“This book is an essential resource for every educator that works with students with ASD! The easy-to-read format is complete with up to date research on evidence-based practices for this population, sample observation and assessment worksheets and case studies that allow the reader to apply the information presented.” - Gena P. Barnhill, PhD, NCSP, BCBA-D, LBA, Director of Special Education Programs at Lynchburg College, Lynchburg, VA

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